Ankle Surgery?

I been having problems resolving an anterior tibial strain for 6 months.

I developed sesamoiditis last year and was eventually prescribed othotics. I had tried to run in them, developed some other pain laterally in foot that felt better being out of orthotics for a few days. The toe wasn't ready for this and I was straining tib muscle trying to minimize impact to toe. I know, bad move.

I have gotten it to the point a couple of times to be pain free only to aggravate again either by too much activity or too much PT stretching and strengthening. X ray and bone scan negative for stress fracture. Ultrasound, estim and ART have already been tried. I have seen more than one ortho and DPM. For the last 4 weeks, I shut myself down completely hoping the extended rest would heal. I'm still getting pain just from minimal walking unless I use Voltaren gel. I am making some progress. Mornings are going better.

I attempted to "bite the bullet" and just boot it, but it seemed to aggravate the problem, especially at ankle joint. Went to another DPM. He noticed ankle instability and ordered MRI.

I was shocked. Apparently, this is from injury that occured 30 years ago (skiing). I had 2 or 3 instances were I had rolled the ankle since(basketball). Last time was about 15 years ago and have had no problems with instability since.

About 10 years ago, I became active. Mostly running & including races (up to and including marathon). I reduced running and started hiking a few years ago. I haven't been able to run since my sesamoid problem last year. Throughout all of this, I haven't rolled the ankle nor have had any other problems. It never felt unstable either running or on difficult and uneven terrain hiking. I can't believe what all I have done on it without a problem in light of the MRI results.

DPM recommends surgery for ligaments. I not sure I want to go through with it, at least not yet. I am battle weary from all the dr visits and pt i have undergone the past 15 months with the toe and ankle. I'm depressed from all the inactivity. The surgery will require 6 more months of even more rigorous rehab. I not sure I can handle it at this point.

I have read where some people have had trouble afterwards with the surgery and have no desire to add to my problems.

My ultimate questions are how much can I benefit from the surgery at this point in my life? Is the ankle instability significantly impairing ability for ant tib to heal?